SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Rectal Metastasis With Malignant Bowel Obstruction From Urothelial Carcinoma

Pdf Summary

This case describes a 65-year-old man with bilateral nephrostomy tubes who presented with abdominal distention and severe hyponatremia. Imaging showed severe colonic distention, and CT of the abdomen/pelvis revealed new distal sigmoid and rectal wall thickening with pelvic fat stranding that had not been present one month earlier. Rectal MRI demonstrated diffuse rectal wall edema and mesorectal enhancement, and flexible sigmoidoscopy found a 3 cm rectal mass.<br /><br />His hospital course was complicated by bilateral deep vein thromboses and pulmonary emboli. Because of worsening distention, he underwent exploratory laparotomy, which revealed a 6 cm cecal serosal tear. He underwent decompression and diverting colostomy with repeat biopsy. Pathology confirmed high-grade, poorly differentiated urothelial carcinoma. He was later readmitted with bloody nephrostomy output, an Enterococcus faecium urinary infection, and a cerebrovascular accident with multifocal embolic infarcts. Ultimately, care was changed to comfort-focused management.<br /><br />The discussion highlights that rectal metastasis from urothelial carcinoma is extremely rare, with fewer than 20 cases reported. Urothelial carcinoma more commonly spreads to lymph nodes, liver, lungs, and bone; colorectal involvement usually indicates advanced, aggressive disease and a poor prognosis. In this patient, recurrent urinary infections and persistent bladder wall thickening initially masked the underlying malignancy.<br /><br />The case emphasizes that atypical gastrointestinal symptoms, especially bowel obstruction or rectal bleeding, can be the first sign of metastatic urothelial carcinoma. Clinicians should reconsider malignancy in patients with persistent bladder abnormalities, hematuria, rectal bleeding, or unexplained bowel obstruction.

Asset Subtitle

Mustafa Naveed

Meta Tag

Author List Adam Hoch, Amira Elsabagh, Chad DeMott, Mustafa Naveed

Category Clinical Vignettes

Concept Urothelial Carcinoma

Concept Metastasis

Concept Colorectal Metastasis

Concept Bowel Obstruction

Concept Hematuria

Distinguished Non-Finalist

Presenter Organization Virginia Tech Carilion Department of Internal Medicine

Presenting Author Mustafa Naveed

Track Adult

Keywords

urothelial carcinoma

rectal metastasis

bowel obstruction

hyponatremia

nephrostomy tubes

colonic distention

pelvic fat stranding

rectal mass

deep vein thrombosis

pulmonary embolism

Urothelial Carcinoma

Metastasis

Colorectal Metastasis

Bowel Obstruction

Hematuria